Can Non-invasive Ventilation Modulate Cerebral, Respiratory, and Peripheral Muscle Oxygenation During High-Intensity Exercise in Patients With COPD-HF?

Cássia Da Luz Goulart,Flávia Rossi Caruso,Sílvia Cristina Garcia De Moura,Piergiuseppe Agostoni,Audrey Borghi-Silva,Renata Gonçalves Mendes,Aparecida Maria Catai,Ross Arena,Adriana Sanches Garcia De Araújo

doi:10.3389/fcvm.2021.772650

Abstract

AimTo evaluate the effect of non-invasive positive pressure ventilation (NIPPV) on (1) metabolic, ventilatory, and hemodynamic responses; and (2) cerebral (Cox), respiratory, and peripheral oxygenation when compared with SHAM ventilation during the high-intensity exercise in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF).Methods and ResultsOn separate days, patients performed incremental cardiopulmonary exercise testing and two constant-work rate tests receiving NIPPV or controlled ventilation (SHAM) (the bilevel mode—Astral 150) in random order until the limit of tolerance (Tlim). During exercise, oxyhemoglobin (OxyHb+Mb) and deoxyhemoglobin (DeoxyHb+Mb) were assessed using near-infrared spectroscopy (Oxymon, Artinis Medical Systems, Einsteinweg, The Netherlands). NIPPV associated with high-intensity exercise caused a significant increase in exercise tolerance, peak oxygen consumption ( in mlO2·kg−1·min−1), minute ventilation peak ( in ml/min), peak peripheral oxygen saturation (SpO2, %), and lactate/tlim (mmol/s) when compared with SHAM ventilation. In cerebral, respiratory, and peripheral muscles, NIPPV resulted in a lower drop in OxyHb+Mb (p < 0.05) and an improved deoxygenation response DeoxyHb+Mb (p < 0.05) from the half of the test (60% of Tlim) when compared with SHAM ventilation.ConclusionNon-invasive positive pressure ventilation during constant work-rate exercise led to providing the respiratory muscle unloading with greater oxygen supply to the peripheral muscles, reducing muscle fatigue, and sustaining longer exercise time in patients with COPD-HF.

Highlights

The coexistence of chronic obstructive pulmonary disease (COPD) and heart failure (HF) typically results in severe impairments in the cardiorespiratory fitness (CRF), including exercise capacity, ventilatory efficiency, oxygen supply to working muscle, and peripheral muscle function
14 patients diagnosed with COPD-HF completed all visits and protocols proposed for the current study (Figure 2)
Several aspects make this study are novel and meaningly add to the literature. This is the first study to investigate the effects of respiratory muscle unloading on respiratory, peripheral muscle, and cerebral oxygenation in patients diagnosed with COPD and HF, a frequently observed multimorbidity phenotype in clinical practice

Summary

Introduction

The coexistence of chronic obstructive pulmonary disease (COPD) and heart failure (HF) typically results in severe impairments in the cardiorespiratory fitness (CRF), including exercise capacity, ventilatory efficiency, oxygen supply to working muscle, and peripheral muscle function. Interventions aimed at improving the peripheral muscle dysfunction, unloading respiratory muscles during exercise, and local energy supply to the locomotor muscles are of great importance. In this context, the employment of noninvasive positive pressure ventilation (NIPPV) may prove useful in improving exercise tolerance (8) by increasing blood flow and oxygenation to muscle groups integral to the exercise response (4). A major pathophysiological consequence in resting cerebral oxygenation is found in patients with coexistence of COPD-HF and these abnormalities are accentuated during exercise (9)

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